The Downstream Effects of COVID-19 on Adolescent Girls in the Amazon Basin: How the Pandemic Affected Educational Attainment and Reproductive Health

Abstract

The initial effects of COVID-19 were tracked using metrics like case counts, case fatality rates, and cumulative deaths. However, as we move beyond the pandemic, it is essential to understand the long-term, downstream effects it has had on individuals, families, and communities. In countries like Peru, which held the record of the world’s highest COVID-19 case fatality rate, mitigation efforts included closed borders, prolonged school closures, and limited population mobility. These measures may have had adverse public health outcomes. This research focuses on the pandemic's influence on the educational achievements and reproductive health of adolescents in Loreto, an Amazonian region in northeastern Peru. This was achieved by triangulating findings from three different methodologies including: (1) a secondary analysis of annual demographic health data (n=688); (2) a multimodal qualitative study (n=41 interviews, n=3 focus group discussions); and (3) a pilot survey (n=162). The findings yielded different, and at times contradictory, insights into adolescent pregnancy as an outcome of the pandemic, possibly attributed to the methodological constraints in data collection. While there was no association between COVID-19 and adolescent pregnancy in our secondary data analysis, we observed that school dropouts were significantly more likely to experience adolescent pregnancy (adjusted odds ratio (adjOR) 3.54; 95% confidence interval (CI) 2.09-6.02). The qualitative data provided an in-depth understanding of how the school dropout, whether temporary or permanent, and adolescent pregnancy during COVID-19, were both a cause and consequence of the other. Lastly, the regression analysis using pilot survey data suggested that experiencing hunger during COVID-19 was associated with two times greater odds of school dropout (adjOR 2.46; 95% CI 1.14-5.33).